Do GLP-1 medications affect fertility and the menstrual cycle?

Polycystic ovary syndrome (PCOS) is a common hormonal condition, affecting an estimated 8–13% of reproductive-age women worldwide, with many cases remaining undiagnosed.¹ 

Beyond its well-known implications, such as insulin resistance and obesity, PCOS is a leading cause of infertility due to irregular menstrual cycles and hormonal imbalances.¹

How do medical treatments help manage PCOS?

PCOS is marked by irregular periods or no periods at all and ovaries that may contain many small cysts. PCOS can often cause infertility because it prevents regular ovulation.²

One of the key features of PCOS is hyperandrogenism, which refers to elevated levels of androgens like testosterone. This hormonal imbalance can lead to symptoms such as excessive hair growth, acne, and thinning scalp hair.²

While lifestyle changes and dietary improvements are often the first steps in managing PCOS, particularly when it comes to weight, medications can also play a crucial role. Recent studies suggest that GLP-1 medications may offer benefits for some women.⁴

Evidence from recent research

A recent meta-analysis of 11 randomised controlled trials, including 840 participants, examined the effects of GLP-1s on reproductive and metabolic outcomes in women with PCOS.⁴

The study found that women receiving GLP-1s were 72% more likely to achieve natural pregnancy compared to those in control groups through three perceived reasons: direct weight loss, the role of GLP-1’s on regulating the expression of certain steroid hormones, and through the reduction of inflammation, though more research is required to ascertain these benefits. No significant differences were observed in IVF-related pregnancy rates.⁴

GLP-1s were also shown to significantly improve menstrual regularity. Women taking these medications experienced more frequent periods, with longer treatment durations (e.g. 24 weeks or more) showing the most noticeable improvements.⁴

Improvements in menstrual cyclicity and metabolic health

Beyond emerging potential benefits to reproductive health, GLP-1s offered substantial metabolic benefits:

• Significant reductions in BMI and waist circumference.

• Improved insulin sensitivity, as indicated by lower HOMA-IR scores.

• Increased levels of sex hormone-binding globulin (SHBG), which helps regulate androgen activity.

These improvements may prove critical for women with PCOS should GLP-1 medications obtain the appropriate authorisation, as managing weight and insulin resistance can significantly improve overall health and fertility.⁴

The numan take

The emerging evidence suggests that GLP-1 medications can enhance both reproductive and metabolic health in women with PCOS. By improving natural pregnancy rates and menstrual cyclicity, these medications may serve as a valuable option for women struggling with PCOS-related infertility. However, further research is needed to explore long-term effects and optimise treatment strategies.

^{Do note that GLP-1 medicines are not currently licensed for reproductive health, including the treatment of PCOS. Using these medicines outside of their license and use against the advice of a practitioner can be dangerous. This article is for informational purposes only.}

References

1. World Health Organization. (2023, June 28). Polycystic ovary syndrome. WHO. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome

2. NHS. (2022). Polycystic ovary syndrome (PCOS): Overview. NHS. https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/ 

3. Attia G M, Almouteri M M, Alnakhli F T (August 31, 2023) Role of Metformin in Polycystic Ovary Syndrome (PCOS)-Related Infertility. Cureus 15(8): e44493. doi:10.7759/cureus.44493 

4. Meta-analysis on GLP-1 receptor agonists and PCOS outcomes. BMC Endocrine Disorders. doi:10.1186/s12902-023-01500-5